Anaphylaxis in Schools 3rd Edition

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Appendix G Foods with “May Contain” Warnings Products with a ‘may contain’ warning could be problematic for individuals with life-threatening food allergies if ingested. Individuals with food allergy should not eat products which have a ‘may contain’ warning with respect to their allergen(s). However, foods with a precautionary warning should not be an issue if consumed by non-allergic children in the presence of older children with food allergies. Regular hand washing, cleansing of surfaces, and adult supervision of young children while eating are still advised as a precautionary measure. (Note: Precautionary labels such as ‘may contain’ are put on by food manufacturers at their own discretion.) Reading Food Labels While it is the responsibility of allergic consumers to always read food labels, confusion can be created by strong brand awareness and unfamiliarity with food labelling regulations. Here are some examples which consumers need to be aware of: • Some popular brands which are widely recognized as being safe for allergic consumers may be used in other products which may contain peanut/nuts (e.g. peanut-free chocolate in ice cream which has a ‘may contain’ warning). • An allergen-free claim on certain products may be specific to only one size or format of the brand, not to all products using the same brand name. In some cases, the brand name has been used in new products which contain the allergen. • Product formulations (recipes) may change and ingredients of a particular brand may not be the same in all formats or all sizes. For example, a regular size candy bar may be considered to be free of an allergen such as peanut; however, the snack size version could have a ‘may contain peanuts’ warning. This could be due to the risk of cross-contamination if the product is run on the same equipment as products which contain peanut. Products may also be produced in a different format or in a different production factory. • Food labelling standards in other countries may not be the same as Canada’s. Imported products may pose a risk to allergic consumers. Researchers found that 62% of imported chocolate bars from Eastern Europe without a precautionary label actually contained detectable levels of peanut protein. 8 Food-allergic individuals and those who buy on their behalf must read food ingredient labels every time they purchase a product, as product ingredients and labelling may change. Food-allergic consumers are encouraged to read food ingredient labels three times: once when purchasing an item, a second time when putting the product away, and a third time just before serving. Cleaning Surfaces A U.S. study suggests that liquid or bar soap and antibacterial wipes can effectively remove peanut butter residue from hands. However, anti-bacterial hand sanitizers and water alone are not as 46 Anaphylaxis in Schools & Other Settings Copyright © 2005-2014 Canadian Society of Allergy and Clinical Immunology
effective. 9 In the same study, researchers found that common household cleaning products such as Formula 409 ® (Clorox), Lysol ® sanitizing wipes, and Target brand cleaner with bleach were effective in removing residual peanut allergen from surfaces. Not all products may be available in Canada, but the research suggests that comparable products would work equally well. Dish soap did not effectively remove residue of peanut butter from surfaces. 9 Appendix G Food Lists Many schools provide a list of ‘safe foods’ to all families to help them comply with a ‘no peanut or tree nut’ request. While this is well-intended, schools and food-allergic consumers are encouraged to use them as a guideline only. Many of these lists could be inaccurate or outdated. Parents of children with food allergy should teach them to always read food ingredient labels and not to accept or share foods which the parents have not approved, even in so-called ‘peanut-free’ schools. It is unrealistic to expect others who are not affected by food allergies to understand the details required to properly read a food label. Some people may assume that a product is okay if there is no ‘may contain’ warning (which is voluntarily put on by manufacturers). References: 1. Ben-Shoshan M, Kagan RS, Alizadehfar R, Joseph L, Turnbull E, St. Pierre Y, Clarke A. Is the Prevalence of Peanut Allergy Increasing? A Five-year Follow-up Study on the Prevalence of Peanut Allergy in Montreal School Children Aged 5 to 9 Years, Journal of Allergy and Clinical Immunology 2008;121(2): S97. 2. Ben-Shoshan M, Harrington DW, Soller L et al. A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. Journal of Allergy and Clinical Immunology 2010;125:1327-35. 3. Sampson HA. Update on Food Allergy (Review). Journal of Allergy and Clinical Immunology 2004;113:805-19. 4. Sampson HA, Mendelson LM, Rosen JP. Fatal and near-fatal anaphylactic reactions to foods in children and adolescents. New England Journal of Medicine 1992;327:380-4. 5. Bock SA et al. Further fatalities caused by anaphylactic reactions to food, 2001-2006. Journal of Allergy and Clinical Immunology 2007;Letter to the Editor 119(4):1016-1018. 6. Vander Leek TK, Liu AH, Stefanski K, Blacker B, Bock SA. The natural history of peanut allergy in young children and its association with serum peanut-specific IgE. Journal of Pediatrics 2000;137:749-755. 7. Simonte SJ, Songhui Ma, Mofidi S, Sicherer SH. Relevance of casual contact with peanut butter in children with peanut allergy. Journal of Allergy and Clinical Immunology 2003;112:180-2. 8. Vadas P, Perelman B. Presence of undeclared peanut protein in chocolate bars imported from Europe. Journal of Food Protection 2003, Vol. 66, No. 10, pp. 1932-1934. 9. Perry T, Conover-Walker MK, Pomés A, Chapman M, Wood RA. Distribution of peanut allergen in the environment. Journal of Allergy and Clinical Immunology 2004;113:973-6. Anaphylaxis in Schools & Other Settings Copyright © 2005-2014 Canadian Society of Allergy and Clinical Immunology 47
Page 1 and 2: Anaphylaxis in Schools & Other Sett
Page 3 and 4: Copyright © 2005-2014 Canadian Soc
Page 5 and 6: Table of Contents Table of Contents
Page 7 and 8: Executive Summary Executive Summary
Page 9 and 10: Consensus Statement Consensus State
Page 11 and 12: If an allergic person expresses any
Page 13 and 14: Other Factors to Consider • Prev
Page 15 and 16: 3. All individuals receiving epinep
Page 17 and 18: Avoidance Strategies Consensus Stat
Page 19 and 20: -- Stay away from areas where sting
Page 21 and 22: child/school with an epinephrine au
Page 23 and 24: Training & Communication Consensus
Page 25 and 26: References Consensus Statement 1. S
Page 27 and 28: Appendices Consensus Appendices Sta
Page 29 and 30: of position may lower their blood p
Page 31 and 32: School Anaphylaxis Plan Appendix C
Page 33 and 34: • Have the child wear medical id
Page 35 and 36: Given that anaphylaxis can be trigg
Page 37 and 38: Anaphylaxis Emergency Plan: (name)
Page 39 and 40: HOW TO USE ALLERJECT TM Practice Wi
Page 41 and 42: Think F.A.S.T. Appendix E Anaphylax
Page 43 and 44: Sample Letter from Teacher (element
Page 45 and 46: Avoidance Strategies for Specific F
Page 47 and 48: Avoidance of Peanut and Tree Nuts A
Page 49: look for ‘may contain’ warnings
Page 53 and 54: Teens must be able to resist peer p
Page 55 and 56: Anaphylaxis in the Workplace Append
Page 57 and 58: Manitoba Since 1995, Manitoba has b
Page 59 and 60: On January 1, 2012 the Ontario Mini
Page 61 and 62: • A requirement that every schoo
Page 63 and 64: Idiopathic reaction: a reaction tha
Page 65 and 66: Anaphylaxis Canada Anaphylaxis Cana
Page 67 and 68: OTHER ORGANIZATIONS Appendix L Alle
Page 69 and 70: Health Canada (Food Directorate) Th
Page 71 and 72: Association of Allergists and Immun
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